Can takotsubo syndrome be rapidly diagnosed in the emergency department? A case study.

Some patients presenting with acute coronary syndrome may have had nonobstructive coronary arteries. Nevertheless, a lot of people are not aware that, as of the fourth universal definition of myocardial infarction, Takotsubo syndrome is no longer categorized as myocardial infarction with non-obstructive coronary arteies group. This can lead to diagnostic delays, the use of unnecessary examination, and harmful medical intervention. We present a 68-year-old woman with typical chest pain for 6 h. She had a history of hypertension, transient ischemic attack, and diabetes mellitus. She was diagnosed first with acute coronary syndrome but was later found to have takotsubo syndrome, based on high international takotsubo diagnostic score and transthoracic echocardiography findings of systolic apical ballooning. Within 5 days, she makes a gradual recovery.

Diagnosing STEMI in right then left bundle branch block pattern ventricular escape rhythm (case report).

Electrocardiography is the fastest bedside tool for rapidly identifying patients with acute coronary syndromes who require emergency reperfusion therapy. Some of the circumstances that make identification more complex are bundle branch block patterns. ST elevation in the right bundle branch block (RBBB) can still be detected, but the left bundle branch block (LBBB) must use specific criteria such as Sgarbossa and Barcelona. We present a patient with anteroseptal ST-segment elevation (STEMI), total AV block (TAVB) with ventricular escape rhythm RBBB pattern, and then turned into a LBBB pattern. Fortunately, it immediately turned into sinus rhythm after reperfusion therapy. It is essential to be able to identify STEMI in patients with BBB patterns. In addition, to provide the best possible outcomes for the patient, we must understand that the best way to manage STEMI with TAVB is to immediately install a temporary pacemaker and initiate reperfusion therapy.

Rapid Atrial Fibrillation in the Emergency Department.

Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.

Posterior Myocardial Infarction in a 45-Year-Old Javanese Woman with a 1-Month History of COVID-19-Related Guillain-Barré Syndrome: A Challenging Emergency Diagnosis.

BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune demyelinating disease that affects peripheral nerves and may be associated with nerve pain in the upper limbs and chest. Autonomic dysfunction in GBS can result in electrocardiography (ECG) changes that include T wave inversion, ST segment depression, or ST segment elevation. Recently, GBS was been recognized as a neurological consequence of COVID-19. This report describes the challenge of emergency diagnosis of posterior myocardial infarction (MI) in a 45-year-old Javanese woman who was known to have a 1-month history of COVID-19-related Guillain-Barre syndrome. CASE REPORT We report the case of a 45-year-old patient who presented to the Emergency Department (ED) with atypical angina. She had a history of GBS that started 2 weeks after she developed COVID-19. Since then, she frequently had pain in both legs and occasionally in the chest. Her electrocardiogram revealed subtle ST segment depression in the anteroseptal leads (V1-V4), along with ST segment elevation in the posterior leads (V7-V9). Cardiac marker (troponin I) was elevated and posterior regional wall motion abnormality was present on an echocardiogram. Coronary angiography revealed total occlusion of the first diagonal branch of the LAD, followed by deployment of drug-eluting stents to achieve good angiographic results. The patient was diagnosed with GBS and isolated posterior ST segment elevation myocardial infarction. CONCLUSIONS This report shows the importance of performing standard cardiac investigations for myocardial ischemia or infarction in patients known to have Guillain-Barre syndrome so that the patient can be treated appropriately and urgently to ensure the best possible outcome.

The association of depression and central obesity on hypertension in Indonesian provinces: a path analysis of the Indonesian baseline health research 2018 data.

Purpose: This study aims to analyse the direct and indirect relationship between the prevalence of depression and hypertension through central obesity in the Indonesian population.Material and methods: This quantitative analytical observational study is based on secondary data with a cross-sectional design. The data is taken from the Indonesian Baseline Health Research of the Health Research and Development Agency in 2018, which is aggregated data from survey results on household members in 34 Indonesian provinces. We used path analysis and the Sobel test using AMOS 23.0 program to assess the direct and indirect relationship of depression and obesity to hypertension. Multiple linear regression analysis was used to determine the effect of confounding factors on hypertension.Results: The average prevalence (± SD) of depression, central obesity and hypertension in 2018 was 6.21% (± 2.30), 31.26% (± 4.80), and 31.07% (± 4.76). There was an indirect positive relationship between depression and hypertension through central obesity (p = 0.041). The direct effect of depression was associated with a 17% chance of being centrally obese (p = 0.009), and the direct effect of depression and central obesity was associated with a 32.7% chance of becoming hypertensive (p = 0.001). There is no significant direct relationship between depression and hypertension. The effect of confounding factors on hypertension was 21.9% (p = 0.007), lower than the effect of depression and central obesity.Conclusion: Central obesity might be an intermediate variable linking depression and hypertension.